Intensive glucose control and cardiovascular outcomes.
Intensive glucose control and cardiovascular outcomes.
复制标题
强化血糖控制和心血管结局。
DOI：
10.1016/s0140-6736(09)61479-3
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Krumholz,HM
中科院分区：
文献类型：
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作者：
Lipska,K;Inzucchi,SE;Kosiborod,M;Krumholz,HM
Kausik Ray及其同事的荟萃分析（5月23日，第1765页）1表明，强化降糖对冠心病（CHD）有显著益处，但对卒中结局无显著益处。这些数据提供了比较胆固醇、血压和高脂血症与血管疾病相关性的机会。该表显示了在相关变量水平较低的个体中心血管事件发生率的预期（流行病学）降低，2，3以及来自关于干预性降低风险因素效果的荟萃分析1，3-5的数据。这些数据表明，与胆固醇或血压相比，高血压是一个非常弱的危险因素。在可逆性方面，所有干预措施都显示出约三分之二或更多的CHD风险预期降低。然而，对于中风，降低胆固醇和血压似乎完全逆转了过度风险，而强化的血糖控制没有显著的贝内。由于在所有血液病对照研究中，猝死和意外死亡未被归类为CHD终点，因此CHD获益的估计可能被夸大。事实上，总死亡率的估计数在强化贫血控制的情况下没有变化。（6项研究：1.01，95%CI 0.90 - 1.14; 4项研究：1.01，0.93 - 1.10）。该表还显示了需要治疗的人数（NNT），假设10年CHD风险为17.4%，卒中风险为5.0%（即UKPDS中的对照组）。即使治疗使高血脂症对中风和冠心病的影响完全可逆，10年的NNT仍然比胆固醇和血压高50%以上。相比之下，UKPDS人群中严重微血管并发症的10年NNT计算值为单眼失明102，预防肾衰竭518。他汀类药物和较新的抗高血压药物提供了简单的治疗方案，并且相对没有副作用。相比之下，强化降糖需要每天注射几次药物，可能会产生严重的副作用，并涉及用手指针刺样本进行监测，对生活质量有显着影响。
The meta-analysis by Kausik Ray and colleagues (May 23, p 1765) 1 suggests that intensive glucose lowering has significant benefit on coronary heart disease (CHD) but not stroke outcomes. The data provide the opportunity to compare cholesterol, blood pressure, and hyperglycaemia in terms of their associations with vascular disease. The table shows the expected (epide mi o logical) reductions in the incidence of cardio vascular events in individ uals with lower levels of the variables in question, 2, 3 as well as data from meta-analyses1, 3–5 on the effect of interven tional risk-factor lowering. The data suggest that glycaemia is a substan tial ly weaker risk factor than is cholesterol or blood pressure. In terms of reversibility, all interventions show around two-thirds or more of the expected reduction in CHD risk. For stroke, however, cholesterollowering and blood-pressure-lowering seem fully to reverse excess risk, whereas intensive glycaemic control is without signi ficant bene fit. Because sudden and unex pected death was not classified as a CHD endpoint in all glycaemic control studies, the estimate of CHD benefit could be exaggerated. Indeed, estimates for total mortality are unchanged with intensive glycaemic control (six studies 1· 01, 95% CI 0· 90–1· 14; four studies: 1· 01, 0· 93–1· 10).The table also shows numbers needed to treat (NNT) by assuming a 10-year risk of 17· 4% for CHD and 5· 0% for stroke (ie, those for controls in the UKPDS). Even if treatment produced full reversibility of the effect of hyperglycaemia on stroke as well as CHD, the NNT for 10 years would still be more than 50% higher than those for cholesterol and blood pressure. For comparison, calculation of NNT for 10 years for serious microvascular complications in a UKPDS population are 102 for blindness in one eye, and 518 for prevention of renal failure. Statins and newer antihypertensive agents provide simple regimens and are relatively free from side-effects. By contrast, intensive glucose lowering requires drugs that might have to be injected several times a day and that can produce severe side-effects, and involves monitoring with fingerprick samples, having a significant effect on quality of life.